Step 1 Drugs #2

Front 1

Lithium major toxicity

Back 1

Nephrogenic Diabetes Insipidus

Lithium blocks the response of principal cells of renal collecting duct to ADH (post pit). Pts cannot concentrate urine and experience severe thirst, polydipsia, and frequent production of dilute urine.

Front 2

Clozapine major toxicity

Back 2

Agranulocytosis.

This is an atypical antipsychotic. Used in Rx. schizophrenia, but may be used in cases of mania that are unresponsive to first line drugs like lithium.

Front 3

SSRI major s/e

Back 3

Anorgasmia.

Fluoxetine, paroxetine, sertraline, ciralopram.

Used to rx major depression.

SIG E CAPS
Sleep changes
Interest loss (anhedonia)****
Guilt

Energy loss

Concentration changes
Appetite changes
PSychomotor abnormalities
Suicidal thoughts

Depressed mood***

Front 4

TCA major s/e

Back 4

Arrythmias

Imipramine, clomipramine, amitryptilyine - block reuptake of NE and 5-HT

Used to treat major depression, OCD, and fibromyalgia.

Front 5

Carbamazepine major s/e

Back 5

Stevens Johnson syndrome

Anti-epileptic used to rx bipolar disorder.

Front 6

Which of the following are contraindicated in asthmatics?

Metoprolol
Alprazolam
Amitryptiline
Buspirone
Fluoextine

Back 6

Metoprolol - Beta blocker will increase risk of bronchospasm. Though it's a beta-1 selective blocker used to treat tachycardia, it has a risk of bronchoconstriction from possible blockade of beta 2 receptors.

Alprazolam - short acting benzodiazepine - anxiolytic. Not c/i. Abuse potential though, so reevaluate use of drug after a few mos.

Amiitryptyline is a TCA.

Buspirone - for GAD as an anxiolytic.

Fluoxetine - SSRI - used for Social phobia. No abuse potential.

Front 7

DOC for social phobias (e.g. performance anxiety)?

Back 7

SSRI like fluoxetine.

No abuse potential.
S/E are well-tolerated.

Irrational fear of social or performance situations that the patient recognizes as irrational. They'll begin to avoid all social situations in order to avert the unpleasant feelings that are aroused. Tends to have insidious onset and remains a chronic problem. Relapse is common after pharmacologic therapy is stopped.

Front 8

Rifampin moa

Back 8

Binds prokaryotic RNA polymerase. The 4 Rs:

Rifampin
rRNA pol
Revs up cytochrome p450
Red secretions

Front 9

Fluoroquinolones MOA

Back 9

along with etoposide (Eukaryotes), they inhibit DNA gyrase (prok topoisomerase II) in order to stop DNA replication.

Front 10

Tetracyclines moa

Back 10

bind 30s subunit on prokaryotic ribosomes, preventing attachment of aminoacyl-tRNA (charged tRNA) - stops protein synthesis.

Bacteriostatic.

Rx Vibrio cholerae, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Francisella tularensis, H. pylori, Borrelia burgdorferi, Rickettsia.

Front 11

Abx that inhibit protein synthesis:

Back 11

Buy AT 30, CCEL at 50

30s:
Aminoglycosides (inhib formation of initiation complex, cause misreading of mRNA(.
Tetracyclines bind 30s and block aminoacyl tRNA from entering acceptor site.

Chloramphenicol binds 50s, inhib peptidyl transferase
Clindamyclin
Clarithromycin (macrolides) - prev release of uncharged tRNA after it has donated its amino acid.
Erythromycin
Linezolid, Lincomycin.

Front 12

Mebendazole moa

Back 12

Antihelminthic - act on Microtubules.

Worms are BENDY.

Also thiabendazole

Front 13

Griseofulvin MOA

Back 13

Antifungal - acts on Microtubules

Prevents microtubule formation in fungal cells

Front 14

Vincristine MOA

Back 14

along with vinblastine, acto on microtubules by blocking microtubule polymerization

M phase specific - Mitotic spindle cannot form.

Used to treat lymphoma and wilm's tumor.

s/e is peripheral neuropathy.

Front 15

Paclitaxel MOA

Back 15

anti-breast/ovarian cancer - stabilizes MT so they can't divide (mitotic spindle cannot break down)

Society is made STABLE by taxes.

Front 16

Colchicine MOA

Back 16

anti-gout - decreases inflammation by stabilizing Micotubules, so WBC can't move to the inflammation site.

Front 17

Oubain MOA

Back 17

inhibits Na/K pump by binding to K site

Front 18

DigoxinMOA

Back 18

directly inhibits Na/K ATPase which leads to indirect inhibition of Na/Ca exchange --> increased Ca2+ in cell --> increased cardiac contractility.

Front 19

Cisplatin MOA

Back 19

alkylating agent

Binds to guanine, forms inter and intra strand cross links.

Used to treat lkung, bladder, ovarian, and testicular cancers.

Front 20

Which immunosuppressant would you use in SLE when NSAIDs have failed?

Back 20

Cyclophosphamide - reserved for SLE pts with significant organ invovlement. Give in combination with glucocorticoids to reduce the titer of antibodies.

Front 21

Treatment of choice for PCP pneumonia MOA?

Back 21

TMP-SMX

Inhibits bacterial folate synthesis.

1. Dihydropteroate synthetase
2. DHFR

Ground glass appearance.

Front 22

Inhibition of folate synthesis

Back 22

TMP-SMX

double whammy!

Front 23

Inhibition of peptidoglycan cross linking

Back 23

Aztreonam

Binds to PCN binding ptn, resistant to Beta lactamase.
G(-) organisms and Pseudomonas aeruginosa (common cause of nosocomial pneumonia in intubated pts + in CF pts).

Front 24

Used for pneumonia in an intubated patient.

Back 24

Aztreonam - inhibits peptidoglycan cross linking, resistant to beta lactamase.

Third gen cephalosporin (Ceftazidime)

Pseudomonas aeruginosa is a common cause of nosocomial pneumonia in intubated pts.

Front 25

Inhibition of ptn synthesis by blocking attachment of aminoacyl-tRNA

Back 25

Tetracycline abx (doxycycline, demeclycycline, minocycline).

Bind 30s unit, prev attachment of charged tRNA.

Used with Mycoplasma pneumoniae.

Front 26

Inhibit ptn synthesis by blocking peptide bond formation

Back 26

Clindamycin - binds 50s subunit. Bacteriostatic.

Abx of choice for G(-) coverage.

Anaerobic infections (Bacteriodides fragilis and Clostridium perfringens).

Also covers MRSA (skin infections (cellulitis), pneumonia (cavitations or abscesses)).

Front 27

Inhibit ptn synthesis by blocking translocation

Back 27

Macrolide abx like clarithromycin, erythromycin, and azithromycin.

Bind 23s rRNA of 50s ribosomal subunit, inhibiting ptn synthesis.

First line rx for pneumonia caused by Strep pneumoniae and Mycoplasma pneumoniae(atypical pneumonia).

Front 28

a man with Hep C undergoes a liver txplant to treat HCC. After surgery, he takes drugs to prevent organ rejection. His BUN and creatinine are high. What is the MOA of his drug?

Blocks clonal expansion of Ag-selected cytotoxic T lymphocytes
Inhib B and T lymphocyte proliferation
Reacts with CD3 part of T lymphocytes
Treats Hep C

Back 28

A - Cyclosporien has nephrotoxic effects, and is used to treat txplant pts.
MOA: binds to cyclophillin, which inhib calcineurin, blocking production of IL-2 and its receptor. IL-2 is needed to differentiate T lymphocytes and for clonal expansion of Ag-selected cytotoxic T lymphocytes.

Also a/w HTN, HLD, hyperglycemia, tremor, GINGIVAL HYPERPLASIA, and hirsutism.

Front 29

Which transplant drug inhibits B and T lymphocyte proliferation?

Back 29

Mycophenolate mofetil

Provides immunosuppression. Not a/w nephrotoxicity. Cyclosporine is.

Front 30

Which transplant drug reacts with CD3 part of T cells?

Back 30

Muromonab-CD3 targets CD3 of T cells. Binding --> cell death and leads to immunosuppression.

Front 31

Which transplant drug treats hep C infection?

Back 31

Ribavirin is used with IFN-alpha to treat chronic hep C infection.

Not part of post-transplant regimen.

Front 32

Blocks Na/K pump in cardiac muscle?

Back 32

Digitalis.

Increasd intracellular Na --> decreased Na/Ca2+ exchanger activity --> increased intracellular Ca2+ --> increased contractility.

Front 33

Used for reducing systemic vascular resistance and arterial pressure, but not angina?

Back 33

Dihydropyridine CCBs.

Amlodipine, Nifedipine, Nimodipine, etc.

Front 34

Selective for myocardium to reduce oxygen demand and rduce coronary vasospasm, but minimal vasodilatory effects - less reflex tachycardia.

Back 34

Non-dihydropyridine CCBs (Verapamil, Diltiazem).

Front 35

Acts on NKCC pump in thick ascending limb of loop of Henle

Back 35

Loop diuretics like Furosemide.

Front 36

Inhibits carbonic anhydrase at the PCT.

Back 36

Acetazolamide.

Reduces body HCO3-.

Can result in type 2 renal tubular acidosis (HCO3 not combined with H+ to make CO2/H2O, which is absorbed. Then intracellular CA converts it back to HCO3 + H+...the HCO3 is reabsorbed into body, H+ is exchanged for Na+).

Front 37

Inhibits NaCl cotransporter.

Back 37

Thiazide diuretics like HCTZ.

Early distal tubule.

Hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, HLD, hyperuricemia, and hypercalcemia.

Front 38

Competitive ALD receptor antagonist --> hyperkalemia and gynecomastia.

Back 38

K+ sparing diuretic - Spironolactone.

Front 39

Blocks Na+ channels in CCD

Back 39

K+ sparing diuretic - Triamterene.

Front 40

Diuretic whose s/e is to stimualte PGE release --> vasocilation of afferent arteriole.

Back 40

Furosemide - loop diuretic that inhibits NKCC channel in thick ascending limb. Abolishes hypertonicity of medulla - preventing concentration of urine.

Front 41

Toxicity pnemonic for loop diuretics:

Back 41

OH DANG!

Ototoxicity,
Hypokalemia
Dehydration
Allergy (sulfa)
Nephritis (interstitial)
Gout

Front 42

Indicated for a pt with widespread edema, HTN, and hypercalcemia dt CHF, and has a sulfa allergy.

Back 42

Ethacrynic acid - same MOA as furosemide (NKCC inhib in TAL of loop of henle) but no sulfa.

NEVER use to treat gout - can cause hyperuricemia.

Front 43

Treatement for BPH?

Back 43

Finasteride - inhibits conversion of testosterone to DHT - thought to have higher DHT receptors on the transitional zone of the prostate --> autocrine/paracrine stimulation of hyperplasia.

Terazosin and tamsulosin - alpha-1(a,d) antagonists, cause relaxation of smooth muscle on prostate.

Front 44

Use for enterobacter spp?

Back 44

Carbapenems (Imipenem and meropenem) - enterobacters ahve Abx resistance via production of beta lactamase.

Front 45

Use for g(-) rods, pneumonia, sepsis, and UTIs?

Back 45

Third gen cephalosporins

Front 46

Use for G(+) bact + some G(-) cocci and spirochetes? Most common adverse rxn is a hypersensitivity rxn.

Back 46

PCN G

Front 47

Use for G9-) bacilli. Adverse fx include nephrotoxicicty and ototoxicity.

Back 47

Gentamycin

Aminoglycoside.

Front 48

Use for Pseudomonas + G(-) rods. Combination drug

Back 48

Piperacillin-tazobactam - extended spectrum PCN + penicillinase inhibitor.

Front 49

Nucleoside analog that inhibits viral reverse transcriptase. Used in treating a pregnant, HIV-infected woman during L&D to reduce risk of txmission to child.

Back 49

Zidovudine.

Prevents incorporation of viral genome into host DNA. Reduces transmission by 70%.

Front 50

Non-nucleoside HIV reverse transcriptase inhibitor - prevents incorporation into host DNA.

Back 50

Efavirenz.

Front 51

Viral protease inhibitor that inhibits assembly of new virus particles.

Back 51

Indinavir, Saquinavir.

Front 52

Which 3 drugs compose the HAART therapy for AIDS-defining illness, low CD4 (<500), or high viral load?

Back 52

2 NRTIs + 1 NNRTI OR 1 protease inhib OR 1 integrase inhib

Front 53

What is the suffix for protease inhibitors?

Back 53

-navir.

e.g. lipinavir, atazanavir, darunavir, fosamprenavir, saquinavir, ritonavir, indinavir.

Pol gene cleaves the polypeptide products of HIV mRNA --> functional parts. Protease inhib prevent maturation of new viruses.

Navir tease a protease.

s/e hyperglycemia, GI intolerance, lipodystrophy, nephropathy hematuria.

Front 54

What category are Tenofovir, Emtricitabine, Abacavir, Lamivudine, Zidovudine, Didanosine, and Stavudine?

Back 54

NRTIs.

competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain.

Tenofovir is a nucleotide analog and DOES NOT have to be activated.

Zidovudine is used during pregnancy to reduce risk of fetal transmission.

Have you dined (vudine) with my nuclear (nucleosides) family?

s/e - BM suppression, peripheral neuropathy, lactic acidosis (nucleosides), rash (no-nucleosides), anemia (zidovudine)

Front 55

What category are nevirapine, efavirenz, and delavirdine?

Back 55

NNRTIs

Bind to reverse transcriptase at site diff from NRTIs.

Do not require phosphorylatioin to be active or compete with nucleotides.

s/e: BM suppression, peripheral neuropathy, lactic acidosis, rash, anemia.

Front 56

Name the HIV drug that inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase?

Back 56

Raltegravir.

s/e Hypercholersterolemia.

Front 57

Drug taken for pregnancy termination:

Back 57

Mifepristone

Progesterone partial agonist with antagonist properties. Interferes with progesterone's ability to maintain pregnancy.

Front 58

Drug taken a few days after mifepristone for pregnancy termination?

Back 58

Misoprostol - stimulates uterine contraction like oxytocin. PGE1 analog. Expulsion of fetal remnants.

Front 59

Clomiphene use for women?

Back 59

Treats infertility

Partial estrogen receptor agonist.

Interferes with negative feedback of estrogen on Hyp and Pit --> increased secretion of GnRH and gonadotropins. Increased stimulation of ovulation.

Front 60

DES use?

Back 60

Was used to treat primary hypogonadism, but it is teratogenic!

Front 61

Ehinyl estradiol use?

Back 61

Synthetic estrogen analog used in combination OCPs.

High dose + progesterone - contraception up to 72 hours post-coitus (Plan B).

Suppresses ovulation when used at constant dose.

Front 62

Monoclonal Ab against human epidermal growth factor receptor 2?

Back 62

Trastuzumab.

This is HER2.

Front 63

Monoclonal Ab against vascular endothelial growth factor?

Back 63

Bevacizumab.

VEGF is produced by cancer cells to promote angiogenesis.

Rx metastatic colon cancer, non-small cell lung cancer.
Slows process ofmacular degeneration and diabetic retinopathy (proliferation of BVs in the eye)

Front 64

Alkylating agent that cros links DNA --> apoptosis.

Back 64

Cyclophosphamide.

Rx non-Hodgkin's lymphoma and breast/ovarian cancer.

Front 65

Anti-tumor Abx that intercalates into DNA, inhibiting topoisomerase II --> DNA damage and cell death.

Back 65

Doxorubicin.

Rx. breast cancer.

A/w CHF.

Front 66

Chemotherapeutic agent useful in estrogen receptor-positive breast cancer.

Back 66

Tamoxifen.

SERM with estrogen-r antagonist effects - binds, blocks estrogen receptors to impede production of estrogen-responsive genes.

Front 67

Monoclonal antibody against IgE

Back 67

Omalizumab

Additional line of treatment for severe asthma

Front 68

Monoclonal Ab against CD20

Back 68

Rituximab

Rx B cell non-Hodgkin's lymphoma.

Front 69

Monoclonal Ab against Glycoptn IIb/IIIa

Back 69

Abciximab

Prevents cardiac ischemia in unstable angina and in pts with percutaneous coronary intervention to prevent clotting.

Front 70

Monoclonal Ab against TNF-alpha

Back 70

Adalimumab

Rx. Crohn's disease, RA, Psoriatic arthritis, Ankylosing spondylitis.

Front 71

Monoclonal Ab against Digoxin

Back 71

Digoxin Immune Fab

Antidote for digoxin intoxication

Front 72

Monoclonal Ab against CD3

Back 72

Muromonab-CD3 (OKT3)

Prevent acute transplant rejection

Front 73

Antimicrobial, antiprotozoal that acts by inducing formation of toxic metabolites within bacterial or protozoal cell.

Back 73

Metronidazole!!

Good rx for Gardnerella vaginalis.

GET GAP on the Metro with metronidazole!

Giardia
Entamoeba
Trichomonas
Gardnerella vaginalis
Anaerobes (Bacterioides, C. diff).

Infection belo the diaphragm (vs. Clindamycin - anaerobic infections above diaphragm).

Used with Clarithromycin and PPI as triple therapy for H. pylori.

Front 74

Binds D-ala D-ala parts of cell wall precursors, inhibiting cell wallmucopeptide formation. USed for g(+) and multi-drug resistant organisms.

Back 74

Vancomycin.

Staph aureus, C. diff.

Front 75

Wider spectrum than PCN that blocks transpeptidase cross linking of CW b binding PCN-BPs.

Back 75

Ampicillin.

PCN-ase sensitive but is combined with clavulinic acid to enhance its spectrum.

G+ and G- infections.

H. influenzae, E. coli, Listeria, Proteus, Salmonella, Enterococci, Shigella.